Posted: June 9, 2023

Mental Health: Dealing with Difficult Family & Health Decisions

Mental health is an essential aspect of one’s overall well-being, and it can significantly impact an individual’s relationships. For older adults, having support and care from family is important for their happiness and overall well-being. As they age, they may experience both physical and psychological changes that limit their lifestyle and their decision-making abilities. When this happens, family members will take on the responsibility of making decisions for their loved ones who are no longer capable of caring for themselves. Keeping in mind that mental health issues and the level of appropriate care for their loved one can strain family relationships and lead to conflicts if not addressed properly, effective communication and shared decision-making can be beneficial approaches when deciding care options for the older adult parent.1 These are also essential tools when helping older adults manage mental health issues and recover from them.

Age-Related Changes & Shared Decision-Making 

Older adults experience age-related changes that affect them physically, psychologically, and socially. Thus, the need for assistance increases with age for activities of daily living. A decline in cognitive capacity during the aging process is common. For older adults who are no longer capable of caring for themselves, a legal decision is made by appointing an individual responsible for their care and finances. Some age-related changes that come with aging include mild cognitive loss such as short-term memory, slower reaction times, and difficulties retaining new information. Hearing impairments, visual changes, and muscle and joint pain are the most common physical changes that older adults go through during the aging process.2 

When these age-related changes are being noticed by loved ones and family, the start of a shared decision-making process should come into play. Shared decision-making is a process that facilitates making choices and involves all participants that are directly linked to older adult-centered care.3 It allows older adults to be a part of their own health care plan when discussing it with their practitioner, family, and/or caretakers. Informed choices create better outcomes and lifestyles for older adults by considering and discussing all opposing views. Concerns and possibilities allow all parties to find common ground that works for all.  

There are many cases where family members are absent until it is time to make important decisions, like moving their parents to a facility. This leaves some older adults feeling abandoned or like they have been left out of the planning process.

Family Involvement in Older Adults’ Care 

When parents become older adults, oftentimes their children find themselves in a reverse role, in which they now have to care for their parents. The family member caring for the older adult might not allow them to be a part of the decision-making process, potentially causing a disagreement. Due to these arrangements, sometimes older adults are stigmatized as weak or dependent. The negative perception of aging has led to many older adults feeling frustrated and neglected by their loved ones, often affecting their mental health. Finding a resolution can be difficult when more than one child is involved in their care because there can be conflicting opinions. One of the ways children can support their parents’ mental health is by being attentive and empathetic to their needs and wants, especially if they have the mental capacity to make their own decisions. The importance of family members being aware of the signs of changes in mental health in older adults is vital. Being able to identify the signs of mental health issues such as changes in behavior, moods, or habits may allow families to work together to identify resources and support networks that can help their older adults manage their mental health effectively.1 Be aware that this can lead to frustration, resentment, and anger. Families can benefit from educating themselves about mental health topics among the aging population. It's important for families to acknowledge the challenges that mental health issues can pose and work together to address them.

Three-Talk Model  

The talking model known as the “three-talk model” allows the family involved in the older adult’s care to discuss all possible options and make the best decision. The “three-talk model” highlights the three main talking points when it comes to decision-making, which include team talk, option talk, and decision talk.3 Team talk is described as a method where all participants involved can discuss choices, support, and goals. Option talk is when participants discuss all possible options with their pros and cons. Decision talk highlights the older adult’s preferences and any concerns they may have.

It's essential to create a safe and non-judgmental space where family members can express their feelings without fear of criticism or rejection. This can involve active listening, validating emotions, and providing comfort and reassurance. Communication is fundamental when involving all family members that want to be a part of the older adult’s care. The distribution of responsibility and constant communication may diminish family disagreements and uncomfortable conversations. Families and their involvement play a critical role in supporting their loved one’s mental health with shared decision-making, listening attentively, and acknowledging the older adult’s needs and wants, which can significantly improve their well-being.